Defining Modern Pulmonary Rehabilitation. An Official American Thoracic Society Workshop Report

Evaluation of the Structure and Health Impacts of Exercise-Based Cardiac and Pulmonary Rehabilitation and Prehabilitation for Individuals With Cancer: A Systematic Review and Meta-Analysis

“…Cardiorespiratory fitness is one of the strongest independent predictors of all-cause, cancer-related, and CVD-related mortality in cancer survivors ( 53 ). Exercise training is the most effective intervention for improving cardiorespiratory fitness and as such should be a cornerstone of multi-modal programs for individuals diagnosed with cancer, similar to contemporary cardiac and pulmonary rehabilitation ( 3 , 4 , 10 ). An important finding from the current meta-analysis is that real-world, exercise-based, multimodal rehabilitation resulted in the same effect size of improvement in VO 2 peak, the gold standard measure of cardiorespiratory fitness, as compared with rigorously controlled randomized controlled trials of exercise training in individuals with cancer reported in a meta-analysis (2.9 vs. 2.8 mL/kg/min) ( 54 ).…”

“…While exercise training provides numerous health benefits, a cancer diagnosis and subsequent treatment introduces a wide range of physical, psychological, and existential (e.g., as their diagnosis relates to potential death) stressors (2) that are unlikely to be adequately addressed by exercise alone. Exercise-based, multimodal rehabilitation programming similar to that offered in existing models of cardiac or pulmonary rehabilitation or prehabilitation prior to surgery includes aerobic exercise training as the cornerstone, in addition to education and/or counselling for nutritional and psychosocial concerns, and risk factor evaluation and management with the goal of promoting self-management strategies and fostering the adoption and maintenance of healthy lifestyle behaviors (3)(4)(5). A comprehensive, multi-disciplinary approach such as this is a holistic potential solution to address the myriad of sequelae associated with cancer.…”

“…The AHA statement also provided guidance for the adaptation of the structure of standard cardiac rehabilitation to encompass cancer-specific considerations and stated the need to establish the science base for cardiac rehabilitation in cancer populations to help establish reimbursement pathways (10). Pulmonary rehabilitation and prehabilitation (i.e., prior to surgery) are similar multimodal models to cardiac rehabilitation that share the core components of exercise training, education, counselling, and risk factor evaluation and management (3,4). Specifically, pulmonary rehabilitation can be defined as "a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies that include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to healthenhancing behaviors."…”

"We are so close; yet too far": perceived barriers to smartphone-based telerehabilitation among healthcare providers and patients with Chronic Obstructive Pulmonary Disease in India

“…Apart from the debilitating respiratory symptoms (exertional dyspnea, cough, and recurring chest infection) that impair everyday activities, the extra pulmonary effects (muscle wasting, balance problems, osteopenia, and mental health problems) impair COPD patients' quality of life ( Cox et al., 2021 ; Wageck et al., 2021 ). Pulmonary rehabilitation ("individually tailored multicomponent intervention encompassing exercise training, diet modification, and lifestyle modification") combined with pharmacological optimization reduces musculoskeletal morbidity, exacerbation risk, and repeated hospitalization in COPD patients, while also improving their quality of life ( Holland et al., 2021 ; Spruit et al., 2013 ; Wouters et al., 2018 ). However, low participation and non-adherence to traditional institutional-based pulmonary rehabilitation (PR) continue to be a barrier to long-term COPD care ( Cox et al., 2021 ; Wouters et al., 2018 ).…”

“…However, low participation and non-adherence to traditional institutional-based pulmonary rehabilitation (PR) continue to be a barrier to long-term COPD care ( Cox et al., 2021 ; Wouters et al., 2018 ). Home-based PR is seen to be more cost efficient due to reduced travel and caregiver strain, more compliance with PR programs, and long-term behavioral change ( Holland et al., 2021 ). However, the presence of a physician or therapist through virtual means may enhance the success of home-based public relations campaigns.…”